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Abstract

Antimicrobial resistance (AMR) is a major global health concern driven by inappropriate antibiotic use across human and animal populations. Recognizing its growing impact, the World Health Organization (WHO) has identified AMR as one of the top global public health threats and, through its Global Action Plan, has emphasized the need for improved awareness, surveillance, and responsible antimicrobial use within a One Health framework. Despite this increasing international attention, community-level evidence from sub-Saharan Africa remains limited, particularly regarding patterns of antibiotic use and public understanding of AMR. This thesis addresses this gap by combining primary epidemiological data with a systematic evidence synthesis to investigate antibiotic-related knowledge, attitudes, and practices (KAP) in two settings: Nouna (Burkina Faso) and Asante Akim North (Ghana).

A cross-sectional household survey was conducted to collect quantitative data on antibiotic use, AMR awareness, and livestock-related practices. Descriptive statistics and multivariable regression analyses were used to assess KAP and identify associated sociodemographic and contextual factors. The results demonstrate that, while self-reported attitudes toward antibiotic use were generally appropriate, knowledge levels were low to moderate, and awareness of AMR was limited. Misconceptions regarding antibiotic effectiveness and the mechanisms of resistance were widespread.

Patterns of antibiotic use were strongly associated with access to healthcare, availability of medicines, and socioeconomic context. In Ghana, semi-urban communities had greater access to antibiotics, often through drugstores, leading to higher rates of self-medication, whereas in Burkina Faso, street vendors and market sellers played a similar role in informal distribution. In both settings, limited access to veterinary services led livestock owners to frequently administer antibiotics without professional guidance, including medicines intended for human use, thereby creating significant risk pathways for resistance development at the human-animal interface.

A systematic review of community-based AMR interventions was conducted to complement the field research and revealed a lack of evidence from low- and middle-income countries, despite a substantial body of interventions in high-income settings, as well as a predominant focus on healthcare professionals rather than the general population. It further indicated that only a small proportion of participants in Ghana and Burkina Faso reported exposure to AMR-related campaigns. Interventions employing multiple communication strategies and sustained engagement were found to be most effective, yet largely absent in the study settings.

Overall, the findings highlight significant gaps in antibiotic knowledge and systemic factors influencing inappropriate antibiotic use, including limited healthcare access and unregulated availability, underscoring the need for targeted, context-specific, and evidence-based interventions. Strengthening community-level surveillance, improving access to regulated healthcare and veterinary services, and implementing locally adapted awareness strategies are critical steps toward mitigating AMR, in line with the World Health Organization’s Global Action Plan. This work contributes epidemiological evidence to support integrated, One Health-oriented approaches in resource-constrained settings.